Use of a feeding protocol to improve nutritional support through early, aggressive, enteral nutrition in the pediatric intensive care unit
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Toni Petrillo-Albarano1, Robert Pettignano, Meheret Asfaw
1Children's Response, Children's Healthcare of Atlanta at Egleston, USA.
Insights
Implementing a new feeding protocol significantly reduced the time to achieve goal enteral nutrition in pediatric intensive care unit patients. This protocol also improved feeding tolerance, decreasing vomiting and constipation.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Evidence-based practice
Background:
- Enteral feeding is crucial for critically ill children.
- Optimizing feeding protocols can improve patient outcomes.
- Previous approaches lacked standardized bowel regimens, potentially impacting tolerance.
Purpose of the Study:
- To assess the impact of a feeding protocol with an integrated bowel regimen.
- To evaluate changes in time to goal enteral feeding.
- To determine effects on feeding tolerance in the pediatric intensive care unit (PICU).
Main Methods:
- Retrospective chart review comparing patients before and after protocol implementation.
- Analysis of 91 patients (pre-protocol) and 93 patients (post-protocol).
- Data collected included time to goal feedings, tolerance (vomiting, diarrhea, constipation), and medication use.
Main Results:
- The protocol group reached goal nutrition significantly faster (median 14 hrs vs. 32 hrs).
- Incidence of vomiting decreased from 20% to 11%.
- Constipation rates reduced from 51% to 33% in the protocol group.
Conclusions:
- A standardized feeding protocol improves the efficiency of enteral nutrition delivery in the PICU.
- The protocol enhances feeding tolerance, evidenced by reduced gastrointestinal morbidities.
- This approach offers a valuable strategy for optimizing care in pediatric critical care settings.
Objective:
To evaluate the effects of instituting a feeding protocol with inclusive bowel regimen on tolerance and time to accomplish goal feeding in the pediatric intensive care unit.
Design:
Retrospective comparison chart review before and after the initiation of a feeding protocol.
Patients:
A total of 91 patients in the year 2000, before the initiation of the protocol, who received nasogastric feedings and 93 patients in year 2002 after the protocol was initiated.
Measures And Main Results:
Patients were selected for review if they received nasogastric tube feedings while in the pediatric intensive care unit. The data were reviewed from time of admission in the pediatric intensive care unit through 7 days of goal feedings or discharge from the pediatric intensive care unit. Data examined included: days in the pediatric intensive care unit and hospital, time to goal feedings, concomitant use of cardiovascular medications, sedation, analgesia, episodes of feedings held, vomiting, diarrhea, and constipation. The protocol group achieved goal nutrition in an average of 18.5 hrs and a median of 14 hrs. The retrospective group achieved goal feedings at an average of 57.8 hrs and a median of 32 hrs (p < .0001). Also noted were a reduction in the percentage of patients vomiting from 20% to 11% and a reduction in constipation from 51% to 33%.
Conclusion:
This comparison study suggests that the institution of a feeding protocol will not only achieve goal feedings at a substantially reduced time but also improve tolerance of enteral feedings in patients admitted to the pediatric intensive care unit.
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